Historically, because of the problems involved in initial limb salvage and the subsequent difficulty of reconstructing large skeletal defects many fractures with significant bone loss were treated by primary amputation. Modern techniques of fracture stabilisation and soft-tissue reconstruction mean

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The management of fractures with bone loss

Segmental bone defects of the tibia present a challenging problem, particularly when they are associated with soft tissue injuries or instability. Various techniques have been reported to treat bone loss in the tibia. This case report describes a patient with massive segmental bone loss associated with a soft tissue injury, which required a flap for coverage. The injury was treated with an ipsilateral fibular transport utilizing an Ilizarov/Taylor spatial frame. At one and a half year follow-up, the patient was able to walk without any support at home and wore a protective shell for outdoor activities. The outcome of this case study indicates that ipsilateral fibular transport using the Ilizarov method is a valuable technique for limb salvage reconstruction.

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Ipsilateral Fibular Transport Using Ilizarov–Taylor Spatial Frame for a Limb Salvage Reconstruction: A Case Report:

Gustilo type IIIC open fractures of the tibia are high-energy injuries necessitating long treatment periods and usually multiple surgical procedures and eventually resulting in high morbidity rates and even amputations. We present here a case involving a type IIIC open tibial fracture with massive loss of the entire tibial diaphysis, which we treated by performing acute tibialization of the fibula after revascularization of the posterior tibial artery in a single-stage emergency operation.

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Acute emergency tibialization of the fibula: reconstruction of a massive tibial defect in a type IIIC open fracture

Background Management of gap nonunion of tibia is difficult for the surgeons, and time consuming for patients with unpredictable results. There are various methods to treat gap nonunion, but each one has its own limitations. We report the outcomes of ipsilateral fibular transposition (Huntington's procedure) for reconstruction of major tibial defects. Methods It is a retrospective study including 4 patients who underwent ipsilateral vascularized transposition of fibula for gap nonunion of tibia. Fibula was transferred to tibia as vascularized pedicle graft in one-staged procedure. Results Single stage fibular transposition was performed in four patients. The transferred fibula united in all patients. Mean follow-up after fibular transposition was 1.2 years. Partial weight bearing started after an average of 5.25 months till hypertrophy of fibula is seen on radiographs than full weight bearing started. The mean time to healing was 7.5 months (range: 5–10 months). Tibialization of fibula occurred in all patients as evident on radiographs. Conclusions Huntington procedure is a simple and technically easy for large tibial defects. It does not require microsurgical skill and implants. The union of transferred fibula is faster than conventional graft as it is a vascularized graft. It is a rational choice for the treatment of large tibial defects in selected cases.

Huntington's procedure revisited.

Massive segmental bone loss due to pantibial osteomyelitis in children reconstructed by medial fibular transport with Ilizarov frame

Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.

NP Badhe

Papers

Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula.